Edit This Favorite

Name:

Category:

Share:

YesNo, Keep Private

What is the actual EMDR session like?

What is the actual EMDR session like?

Eye Movement Desensitization and
Reprocessing (EMDR) is an integrative psychotherapy approach that has
been extensively researched and proven effective for the treatment of
trauma. EMDR is a set of standardized protocols that incorporates
elements from many different treatment approaches. To date, EMDR therapy
has helped millions of people of all ages relieve many types of
psychological stress. Below is a Brief Description of EMDR Therapy.

8 Phases of Treatment

The amount of time the complete treatment
will take depends upon the history of the client. Complete treatment of
the targets involves a three pronged protocol (1-past memories,
2-present disturbance, 3-future actions), and are needed to alleviate
the symptoms and address the complete clinical picture. The goal of EMDR
therapy is to process completely the experiences that are causing
problems, and to include new ones that are needed for full health.
"Processing" does not mean talking about it. "Processing" means setting
up a learning state that will allow experiences that are causing
problems to be "digested" and stored appropriately in your brain. That
means that what is useful to you from an experience will be learned, and
stored with appropriate emotions in your brain, and be able to guide
you in positive ways in the future. The inappropriate emotions, beliefs,
and body sensations will be discarded. Negative emotions, feelings and
behaviors are generally caused by unresolved earlier experiences that
are pushing you in the wrong directions. The goal of EMDR therapy is to
leave you with the emotions, understanding, and perspectives that will
lead to healthy and useful behaviors and interactions.

Phase 1: History and Treatment Planning

Generally takes 1-2 sessions at the
beginning of therapy, and can continue throughout the therapy,
especially if new problems are revealed. In the first phase of EMDR
treatment, the therapist takes a thorough history of the client and
develops a treatment plan. This phase will include a discussion of the
specific problem that has brought him into therapy, his behaviors
stemming from that problem, and his symptoms. With this information, the
therapist will develop a treatment plan that defines the specific
targets on which to use EMDR. These targets include the event(s) from
the past that created the problem, the present situations that cause
distress, and the key skills or behaviors the client needs to learn for
his future well-being. One of the unusual features of EMDR is that the
person seeking treatment does not have to discuss any of his disturbing
memories in detail. So while some individuals are comfortable, and even
prefer, giving specifics, other people may present more of a general
picture or outline. When the therapist asks, for example, "What event do
you remember that made you feel worthless and useless?" the person may
say, "It was something my brother did to me." That is all the
information the therapist needs to identify and target the event with
EMDR.

Phase 2: Preparation

For most clients this will take only 1-4
sessions. For others, with a very traumatized background, or with
certain diagnoses, a longer time may be necessary. Basically, your
clinician will teach you some specific techniques so you can rapidly
deal with any emotional disturbance that may arise. If you can do that,
you are generally able to proceed to the next phase. One of the primary
goals of the preparation phase is to establish a relationship of trust
between the client and the therapist. While the person does not have to
go into great detail about his disturbing memories, if the EMDR client
does not trust his clinician, he may not accurately report what he feels
and what changes he is (or isn't) experiencing during the eye
movements. If he just wants to please the clinician and says he feels
better when he doesn't, no therapy in the world will resolve his trauma.
In any form of therapy it is best to look at the clinician as a
facilitator, or guide, who needs to hear of any hurt, need, or
disappointments in order to help achieve the common goal. EMDR is a
great deal more than just eye movements, and the clinician needs to know
when to employ any of the needed procedures to keep the processing
going. During the Preparation Phase, the clinician will explain the
theory of EMDR, how it is done, and what the person can expect during
and after treatment. Finally, the clinician will teach the client a
variety of relaxation techniques for calming himself in the face of any
emotional disturbance that may arise during or after a session. Learning
these tools is an important aid for anyone. The happiest people on the
planet have ways of relaxing themselves and decompressing from life's
inevitable, and often unsuspected, stress. One goal of EMDR therapy is
to make sure that the client can take care of himself.

Phase 3: Assessment

Used to access each target in a
controlled and standardized way so it can be effectively processed.
Processing does not mean talking about it. See the Reprocessing sections
below. The clinician identifies the aspects of the target to be
processed. The first step is for the person to select a specific picture
or scene from the target event (which was identified during Phase One)
that best represents the memory. Then he chooses a statement that
expresses a negative self-belief associated with the event. Even if he
intellectually knows that the statement is false, it is important that
he focus on it. These negative beliefs are actually verbalizations of
the disturbing emotions that still exist. Common negative cognitions
include statements such as "I am helpless," " I am worthless," " I am
unlovable," " I am dirty," " I am bad," etc. The client then picks a
positive self-statement that he would rather believe. This statement
should incorporate an internal sense of control such as "I am
worthwhile/ lovable/ a good person/ in control" or "I can succeed."
Sometimes, when the primary emotion is fear, such as in the aftermath of
a natural disaster, the negative cognition can be, "I am in danger" and
the positive cognition can be, "I am safe now." "I am in danger" can be
considered a negative cognition, because the fear is inappropriate --
it is locked in the nervous system, but the danger is actually past. The
positive cognition should reflect what is actually appropriate in the
present. At this point, the therapist will ask the person to estimate
how true he feels his positive belief is using the 1-to-7 Validity of
Cognition (VOC) scale. "1" equals "completely false," and " 7" equals
"completely true." It is important to give a score that reflects how the
person "feels," not " thinks." We may logically " know" that something
is wrong, but we are most driven by how it " feels." Also, during the
Assessment Phase, the person identifies the negative emotions (fear,
anger) and physical sensations (tightness in the stomach, cold hands) he
associates with the target. The client also rates the disturbance using
the 0 (no disturbance)-to-10 (the worst feeling you? ve ever had)
Subjective Units of Disturbance (SUD) scale. Reprocessing For a single
trauma reprocessing is generally accomplished within 3 sessions. If it
takes longer, you should see some improvement within that amount of
time. Phases One through Three lay the groundwork for the comprehensive
treatment and reprocessing of the specific targeted events. Although the
eye movements (or taps, or tones) are used during the following three
phases, they are only one component of a complex therapy. The use of the
step-by-step eight-phase approach allows the experienced, trained EMDR
clinician to maximize the treatment effects for the client in a logical
and standardized fashion. It also allows both the client and the
clinician to monitor the progress during every treatment session.

Phase 4: Desensitization

This phase focuses on the client's
disturbing emotions and sensations as they are measured by the SUDs
rating. This phase deals with all of the person's responses (including
other memories, insights and associations that may arise) as the
targeted event changes and its disturbing elements are resolved. This
phase gives the opportunity to identify and resolve similar events that
may have occurred and are associated with the target. That way, a client
can actually surpass her initial goals and heal beyond her
expectations. During desensitization, the therapist leads the person in
sets of eye movement (or other forms of stimulation) with appropriate
shifts and changes of focus until his SUD-scale levels are reduced to
zero (or 1 or 2 if this is more appropriate). Starting with the main
target, the different associations to the memory are followed. For
instance, a person may start with a horrific event and soon have other
associations to it. The clinician will guide the client to a complete
resolution of the target. Examples of sessions and a three-session
transcript of a complete treatment can be found in F. Shapiro & M.S.
Forrest (2004) EMDR. New York: BasicBooks.
http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1

Phase 5: Installation

The goal is to concentrate on and
increase the strength of the positive belief that the person has
identified to replace his original negative belief. For example, the
client might begin with a mental image of being beaten up by his father
and a negative belief of "I am powerless." During the Desensitization
Phase he will have reprocessed the terror of that childhood event and
fully realized that as an adult he now has strength and choices he
didn't have when he was young. During this fifth phase of treatment, his
positive cognition, "I am now in control," will be strengthened and
installed. How deeply the person believes his positive cognition is then
measured using the Validity of Cognition (VOC) scale. The goal is for
the person to accept the full truth of his positive self-statement at a
level of 7 (completely true). Fortunately, just as EMDR cannot make
anyone shed appropriate negative feelings, it cannot make the person
believe anything positive that is not appropriate either. So if the
person is aware that he actually needs to learn some new skill, such as
self-defense training, in order to be truly in control of the situation,
the validity of his positive belief will rise only to the corresponding
level, such as a 5 or 6 on the VOC scale.

Phase 6: Body scan

After the positive cognition has been
strengthened and installed, the therapist will ask the person to bring
the original target event to mind and see if he notices any residual
tension in his body. If so, these physical sensations are then targeted
for reprocessing. Evaluations of thousands of EMDR sessions indicate
that there is a physical response to unresolved thoughts. This finding
has been supported by independent studies of memory indicating that when
a person is negatively affected by trauma, information about the
traumatic event is stored in motoric (or body systems) memory, rather
than narrative memory, and retains the negative emotions and physical
sensations of the original event. When that information is processed,
however, it can then move to narrative (or verbalizable) memory and the
body sensations and negative feelings associated with it disappear.
Therefore, an EMDR session is not considered successful until the client
can bring up the original target without feeling any body tension.
Positive self-beliefs are important, but they have to be believed on
more than just an intellectual level.

Phase 7: Closure

Ends every treatment session The Closure
ensures that the person leaves at the end of each session feeling better
than at the beginning. If the processing of the traumatic target event
is not complete in a single session, the therapist will assist the
person in using a variety of self-calming techniques in order to regain a
sense of equilibrium. Throughout the EMDR session, the client has been
in control (for instance, he is instructed that it is okay to raise his
hand in the "stop" gesture at anytime) and it is important that the
client continue to feel in control outside the therapist's office. He is
also briefed on what to expect between sessions (some processing may
continue, some new material may arise), how to use a journal to record
these experiences, and which techniques he might use on his own to help
him feel more calm.

Phase 8: Reevaluation

Opens every new session At the beginning
of subsequent sessions, the therapist checks to make sure that the
positive results (low SUDs, high VOC, no body tension) have been
maintained, identifies any new areas that need treatment, and continues
reprocessing the additional targets. The Reevaluation Phase guides the
clinician through the treatment plans that are needed in order to deal
with the client's problems. As with any form of good therapy, the
Reevaluation Phase is vital in order to determine the success of the
treatment over time. Although clients may feel relief almost immediately
with EMDR, it is as important to complete the eight phases of
treatment, as it is to complete an entire course of treatment with
antibiotics.

Past, Present and Future

Although EMDR may produce results more
rapidly than previous forms of therapy, speed is not the issue and it is
important to remember that every client has different needs. For
instance, one client may take weeks to establish sufficient feelings of
trust (Phase Two), while another may proceed quickly through the first
six phases of treatment only to reveal, then, something even more
important that needs treatment. Also, treatment is not complete until
EMDR therapy has focused on the past memories that are contributing to
the problem, the present situations that are disturbing, and what skills
the client may need for the future. Excerpts from: F. Shapiro &
M.S. Forrest (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress
and Trauma. New York: BasicBooks.
http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1